Depression

Depression is a psychological condition that affects your feelings, behaviors, and thoughts. You may have feelings of sadness or irritability, a lack of energy, feelings of hopelessness or worthlessness, or unhappy thoughts about yourself or your life. You may even feel that your life is not worth living, or think about hurting yourself. Depression can also affect your physical health: you can have aches and pains all over, or in specific areas such as your stomach. You may have headaches, trouble sleeping, eating, or concentrating, or may not be able to pinpoint what is making you so unhappy.

Who gets depressed?

Depression affects children, teens, and adults of all ages. No one knows the exact number of teens affected by depression, but we do know that it affects a large number of teens, both male and female, from all ethnic and racial backgrounds. Sometimes it happens as a direct result of a stressful or upsetting situation, and sometimes it appears when you would least expect it. It’s important to try to understand the difference between feeling sad or “blue’” – which are typical feelings experienced by everyone at times – and being what is called “clinically depressed”.

What are the symptoms of clinical depression?

You may:

Feel sad or “empty” a lot of the time-these feelings may come and go, but last for at least two weeks.

Not feel like doing things you used to enjoy, such as playing sports, hanging out with friends, or studying. It may be harder to have fun than it used to be.

Feel irritated a lot of the time (things get on your nerves more easily), or you may get angry or lose your temper more easily.

Feel tired or have less energy, or you may be restless and edgy.

Notice changes in your eating habits. You may eat more or less than you did before you started feeling depressed.

Have changes in your sleep, either sleeping a lot more or a lot less than you used to, and/or having trouble falling asleep or waking up.

Find it harder to stay focused and make decisions.

Not feel good about yourself or about anything you do.

Often feel guilty about things that you do or don’t do.

Feel that things will never get better.

Have thoughts about not wanting to live or about hurting yourself, or you may have tried to hurt yourself.

Use drugs or alcohol, or engage in other risky behaviors.

How do I know whether I am depressed or just sad?

It’s normal to feel depressed or sad sometimes. However, if you have some or all of the symptoms above most of the time for at least two weeks, you could have depression. If you are depressed, you may or may not notice changes in yourself, but usually people who are close to you will notice a change in you. Likewise, if you are close to someone who is truly depressed, you may notice a big change in that person’s behavior or mood.

There are no laboratory tests that can be done to prove that you are depressed, like there are for illnesses such as strep throat or diabetes. However, if you think you may be depressed, it’s worth talking with someone about it. A professional who is trained to understand depression, such as your health care provider or a counselor, will be able to ask the right questions to help decide if you are going through a period of sadness or whether you have depression.

What are the effects of depression?

Depression has many different and powerful effects.

Depression can:

Make it harder to work at a job or in school.

Make it more difficult to make and keep friends. It can also become more difficult to get along with family members.

Affect your physical health. For example, you may feel tired or run down all the time.

Make you feel tempted to turn to drugs, alcohol, or sex as a way to escape from your feelings.

Make you feel extremely irritable and cause you to act out in ways that can get you into trouble, such as yelling or fighting.

Cause you to have trouble paying attention, which can lead to car accidents and other mistakes.

What causes depression?

No one knows for sure what causes depression. The most important thing to keep in mind is that it’s not your fault if you become depressed. Most likely, depression is caused by a combination of things, some of which have to do with the chemicals in your brain and some that have to do with what’s happening in your life. Some factors that may put you at risk for depression are:

Genetics – If other people in your family suffer from depression, you may have similar genes and be more likely to get depressed.

Family problems – A major loss in your family or conflict among members of your family may cause you to feel depressed.

Feeling badly about yourself – If you are constantly being put down, abused, or neglected, or if you are having difficulty at school or other activities, you may be more likely to feel depressed.

Feeling alone – Feeling that you are different from others or that your friends and family don’t understand or support you can make you feel depressed. Some examples of people who may feel alone or isolated from others are teens who have just broken up with a boyfriend or girlfriend, teens with medical problems, or teens who have parents or family members going through a difficult time themselves. Teens who identify as LGBTQ+ and who may be struggling with coming out to friends and family members or experiencing bullying or other abusive behaviors as a result of their identity- may be especially susceptible to depression.

These are just a few common examples, but there are many circumstances that can lead to feelings of depression. You may experience many of these things and yet not feel depressed. Or you may not have any of these problems but still feel depressed.

It’s important to talk with someone qualified to help you if you suspect that you are depressed. A trusted adult such as a parent/guardian, teacher, guidance counselor, nurse, health care provider, or clergy person can help you find the right counselor. Your health insurance company keeps lists of mental health providers organized by specialty, so you can ask for a counselor who works with teens. If you ever think that you are going to hurt yourself, it is extremely important to tell someone right away and get help to keep yourself safe: you can always call 911 or go to an emergency room.

What should I do if I’m depressed?

If you think you’re depressed, it may help you to tell a friend, but it is also very important to talk with a parent or an adult with whom you feel comfortable. Friends are great to talk to and often very helpful, but for advice about serious issues, especially those involving safety, it’s important to also talk with an adult. If you don’t feel comfortable telling an adult that you are depressed on your own, you might ask a friend to be with you when you talk with someone, or to help you find someone trustworthy.

Adults you might feel comfortable talking to about being depressed:

Parent, guardian, or other adult relative

Teacher or coach

School counselor

Health care provider

Minister, priest, rabbi, or another clergy person

Any of these adults should be able to help you find a treatment provider who works with depressed teens. If you tell one of these people and they are not able to get you help, tell someone else. You know your feelings best! Sometimes even adults may have a hard time accepting that a teen is depressed, or they may not know what to do.

If you are having an unusually hard time coping with something for up to two weeks, it’s important to talk with someone. Meeting with a counselor may help you figure out how to cope with what you’re experiencing.

What if I’m thinking about hurting myself?

Anyone who has thoughts or feelings about hurting themselves should be taken seriously and should get professional help right away! Suicide is the third leading cause of death in teens and young adults, but it can be prevented with proper intervention and early treatment. It’s important to realize how serious it is to have thoughts about suicide or hurting yourself. When someone is very depressed, they’re not able to think clearly and can become confused or make quick decisions about what to do. You must remember that hurting yourself is never the right thing to do, and that there are people who can help you.

If you think you might hurt yourself, or feel like you want to kill yourself, it’s very important that you talk with a parent, an adult you trust, or someone else who can get you help RIGHT AWAY. If you’re unable to get someone to help you or the adult is unsure what to do, call your local emergency room or 911.

What should I do if I think that one of my friends is depressed?

If you think your friend is depressed, you should try to get him or her to tell an adult, such as a parent, school counselor, or health care provider. If your friend will not get help, you should talk to a trusted adult. This is especially important if your friend has told you or another close friend that they don’t want to live anymore.

You might worry that your friend will be upset with you if you tell an adult. In fact, they may have asked you not to tell anyone. You must remember though, that it is better for your friend to be angry with you at first for telling someone than to possibly hurt him or herself.

How is depression treated?

There are many different kinds of treatment for depression. Deciding on the right treatment for you depends upon how much trouble you are having, what treatment options are available to you, your family’s feelings about how you want to deal with the depression, and the recommendations of your health care provider.

Counseling or Therapy. Counseling or therapy (sometimes called psychotherapy) can help with depression. It includes talking about your thoughts, feelings, and behaviors in a confidential setting. This means that the counselor cannot tell anyone what the two of you talk about, unless you or someone else are in danger. Talking with a counselor can help you realize that someone else understands how you feel and that you are not alone. When you talk about your feelings with a counselor, you learn to understand yourself better and find new strategies for managing your symptoms. When you have depression, it is not unusual to see your life in a distorted way. For example, you may think that you are not good enough, that others don’t like you, or that you are the cause of bad things that are happening. A counselor can help you learn to look at these situations differently. Meeting with a counselor can also help you find ways to cope with your depression and get a better understanding about things that are happening in your life. Counseling can be done in a few different ways. It can be done with a group of teens together, which is called “group therapy”; with a teen and his family, which is called “family therapy”; or alone with a therapist, which is called “individual therapy.” Sometimes a teen will participate in more than one kind of counseling at a time, or begin with one method and move to another. Remember, your counselor is looking out for your best interests.

Medication. If your depression is causing significant problems in your life, or if you feel that counseling isn’t helping enough, your health care provider may suggest medication. Brain chemicals are responsible for some symptoms of depression. For many people with depression, taking medication helps by changing the levels of those chemicals. Sometimes the person you see for counseling will be able to prescribe medication, such as a doctor, a psychiatrist or a nurse practitioner. Other counselors, such as a clinical social worker or psychologist cannot prescribe medication, but will refer you to a mental health provider who can. If this is the case, you will typically continue counseling sessions with your counselor and see the provider who writes your prescriptions less frequently. There are many different medications that treat depression, and it’s important to recognize that sometimes you have to take medication for several weeks before noticing a difference in your symptoms. If you decide to go on medication, it does not mean you will be on it for the rest of your life. Once you have been feeling better for a while, your counselor and your health care provider can talk about lowering the dose or stopping the medication. Remember that even if you are feeling better, you should always talk with your health care provider before making ANY changes with your medicine. You might be concerned about taking medicine for your depression, or you might worry what other people think about it. But many people have found medication to be very helpful. It is very likely that you know and respect someone (such as a teacher, parent doctor or friend) who uses medication for depression, too. Taking medication for depression is just like taking medicine for a physical problem-it is just a way to help yourself get better.

Day Programs and Hospitals. If you become so depressed that you have trouble with your everyday life, or if you are having thoughts about hurting yourself, you may need more help than regular counseling sessions can give you. In this case, you may enter a day program or a hospital. In a day program, you arrive in the morning and spend the day in counseling, group discussions, and activities with mental health professionals and other patients. In a hospital you receive professional care all day and overnight. Both treatments can be very helpful for teens who are severely depressed. Sometimes these are options when you first feel depressed, or may be offered if you have been very depressed for a while and things have not gotten better. A hospital is a place where you can get a lot of support and where mental health professionals can keep you safe. Hospital programs have scheduled activities to help you understand your emotions and figure out how to manage the problems in your life. Often, your family will be involved in your hospital stay and they will get the help they need as well.

Strategies that may help with depression:

Once you have been diagnosed with depression and you are beginning (or considering) some kind of treatment, it is important to have a variety of strategies to help you cope with everyday life.

Talking with a family member or friend about your feelings can often be helpful. Sometimes the people in your life may seem very busy and you might think that your feelings aren’t important enough to take up their time, but they are! It’s helpful to figure out when your family/friend is most available so that you can ask them to set aside some time to talk with you.

Try to keep up with your daily activities, even when you don’t feel 100%. Be sure to do at least one thing each day that you enjoy, and include activities in your daily routine that you know help you relax. Staying as close to a routine as possible is especially important if you are depressed.

Eating healthy foods and being active can help improve your mood. Try to get some kind of exercise for at least 30 minutes, 3 to 4 times a week. It is also important to keep to a regular sleep schedule.

Keeping a journal about your feelings, drawing, and writing poetry are examples of ways you might like to express yourself. Often being able to express your feelings will improve how you feel. Try making a list of strategies that you know work well for you, and keep it somewhere easily accessible.

What else do I need to know?

Depression is more common than you think and most people who receive treatment for depression get better. Unfortunately, many people who are depressed don’t seek help. Some people think that seeking treatment is a sign of weakness. Others are afraid to be seen as “crazy” for seeing a counselor or taking medication. Some people feel that their thoughts and feelings aren’t important enough to concern others, or are none of anyone else’s business. Don’t let these beliefs get in your way! Depression is real and with help you CAN get better.

Remember that you are a worthwhile person who deserves to be heard and understood. Making the choice to get help is the first step to overcoming depression and being your best self. If you EVER feel that you might hurt yourself due to feeling depressed, TELL SOMEONE, call 911, or go to the closest emergency room for help.

Young Men’s Health (YMH) is produced by the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital. The purpose of the website is to provide carefully researched health information to teenage boys and young men.